Important Research, Studies and Articles

Research, Studies and Articles


Washington State PEDIATRIC OPTOMETRISTS List
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By Optometric Physicians of Washington

Could Vision Issues Be Contributing to Your Child's Difficulty With Learning?
By Debbie Walhof, MD and Leonard Press, OD

Beth Born
The story of the teacher who was told she would never read

Vision Exams for Children Prior To Entering School
By National Commission on Vision and Health

SOCIAL, EMOTIONAL, & EDUCATIONAL CONSEQUENCES OF UNDETECTED CHILDREN'S VISION PROBLEMS
Dr. Zaba's Call to Action
By JOEL N. ZABA, M.A., O.D.

Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children
Lead authors: Mitchell Scheiman, OD; Susan Cotter, OD, MS; G. Lynn Mitchell, MAS;Marjean Kulp, OD, MS;Michael Rouse, OD, MEd; Richard Hertle, MD; and Maryann Redford, DDS,MPH.
Additional writing committee members (alphabetical): Jeffrey Cooper, MS, OD; Rachel Coulter, OD; Michael Gallaway, OD; David Granet, MD; Kristine Hopkins, OD, MSPH; Brian G. Mohney, MD; and Susanna Tamkins, OD.

The College of Optometrists in Vision Development
QOL Questionnaire in a socially at-risk population of youth

By Willard B. Bleything, OD, MS, FAAO, FCOVD1, Sandra L. Landis, OD, FCOVD2

"Severe Convergence Insufficiency - a new focus"
Article by Molly Rosbach /Yakima Herald

A CLEAR VISION FOR EQUITY AND OPPORTUNITY
By Gould, Marge Christensen; Gould, Herman

An important study about the CI - ADHD relationship
Study by David B. Granet MD FACS FAAO FAAP, Cintia F. Gomi MD, Ricardo Ventura MD, and Andrea Miller-Scholte CO
Ratner Children's Eye Center, University of California, San Diego

The Vision Program at the Youth ChalleNGe High School
By Willard Bleything OD, MS, and Sandra Landis, OD

Resolution Regarding Learning Related Vision Problems, Education and Evaluation
By the National PTA

Vision Issues in Foster Children - A remarkable progress after Vision Therapy
By Dr. Larry Lefors

And a letter from a foster mother

Underreporting of Concussions and Concussion- Like Symptoms in Female High School Athletes
By Tracy McDonald, MSN, RN / Mark A. Burghart, MOT / Niaman Nazir, MD, MPH

OPTOMETRIC CARE OF THE PATIENT WITH ACQUIRED BRAIN INJURY
A Joint Organizational Policy Statement of the American Academy of Optometry and the American Optometric Association

The Vision Intervention Program at the Youth ChalleNGe High School in Bend, Oregon
By Willard Bleything OD, MS, and Sandra Landis, OD

"Eye" don't see the connection between vision and learning in the Yakima Valley!
Prepared by Barbara Obena, MPH
Edited by Helen Spencer and Katie Johnson

Vision Problems in Children
An Examination of the Vision Problems and Access to Vision Services among Children in Washington
Prepared by: AMERICORPS CHILD VISION PROJECT/2010-2012

An Excerpt of Dr. Bob Mc Laughlin's book
"A Crisis in American Education: A Love Story".

With permission from the author we extracted the part on Binocular Vision from Chapter 9 of his book

Visual Impediments to Learning
A Study from Canada
By N. Piquette, PhD, University of Lethbridge, Lethbridge, Alberta, Canada
Charles Boulet, OD, Black Diamond, Alberta, Canada

The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders
by Kenneth J. Ciuffreda, O.D., Ph.D.
State University of New York, State College of Optometry, Department of Vision Sciences, New York, New York

Recommendations for the new EYE Center for Children's Vision, Learning & Technology at the University of Washington Bothell
Presented by Dr. Kathleen Ross, snjm, President Emerita of Heritage University;
Rhonda Stone, Author, The Light Barrier (St. Martin's Press 2002 & 2003);
Katie Johnson, Retired Teacher and Author;
Mary Pellicer, MD, May 2017

Two Surprising Causes of Photophobia
byBy Greg Mischio

Vision and Audiology Status of Foster Children in New York City
by Trudy Festinger, D.S.W. & Robert Duckman, O.D., M.A

The Visual Screening of Adjudicated Adolescents
by Roger A. Johnson, Ph.D. & Joel N. Zaba, O.D.

OPTOMETRY COMMUNITY OUTREACH EYEVAN
by Pacific University College of Optometry

College of Optometry Awards Larry Jones OD '85 its 2017 Kamelia Massih Prize for a Distinguished Optometrist
by Joe Lang


Beth Born

The story of the teacher who was told she would never read


"Getting a teaching
degree helped that healing
process as a person, and it
also helped me understand
children and where they’re at.
They can do it and they can
overcome. I was there".

Beth Born

Vision Exams for Children Prior To Entering School

by National Commission on Vision and Health
Undetected and untreated eye disorders, such as amblyopia and strabismus, can result in delayed reading and poorer outcomes in school. Studies indicate that visual factors are better predictors of academic success than race or socioeconomic status. However, one in four school-age children suffers from vision problems that could have been treated if the child had been properly screened upon entering school.

Studies show that while prevalence rates vary between demographic groups, there is an increasing need for eye care among children.

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The relationship between Convergence Insufficiency (CI) and ADHD (Attention Deficit Hyperactivity Disorder).

Study by David B. Granet MD FACS FAAO FAAP, Cintia F. Gomi MD, Ricardo Ventura MD, and Andrea Miller-Scholte CO
Ratner Children's Eye Center, University of California, San Diego

Here are some important excerpts from the study:

“The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD.”

“Some of the symptoms of ADHD overlap those of convergence insufficiency (CI). Comparing the Convergence Insufficiency Symptom Survey... with the DSM-IV criteria for ADHD, we noted that 5 of the 9 symptoms of inattention could also be applied for CI (symptoms 1, 2, 4, 6 and 8 as follows). ”

You can find abstracts of the study online at:
www.ncbi.nlm.nih.gov/pubmed/16361187
and http://www.add-adhd.org/convergence_insufficiency.html

Download the original paper



Vision Screening

The Vision Intervention Program at the Youth ChalleNGe High School in Bend, Oregon

By Willard Bleything OD, MS, and Sandra Landis, OD

In 1993, Congress authorized the National Guard to conduct alternative schools for the high school drop out population – a group now recognized as a key public concern.

As can be expected, learning disabilities are a common characteristic in this special population. Of particular significance to this project is the research that has shown visual dysfunction to be a key risk factor in learning disabilities, especially reading skills.

A pilot project at the Youth ChalleNGe High School (YCHS) in Bend was completed in 2004. Forty percent of the students enrolled in this program demonstrated a definite need for professional eye/vision care.

Based upon what we learned in 2004, the aim of the current project is to design a novel, institution-based vision intervention for treating visual dysfunction in the high school drop out population. Specifically, we are working with YCHS - Bend students that were found during a vision screening to need professional visual care. Our goal is to treat the visual dysfunction thus eliminating or reducing this risk factor in learning.

Methodology: A vision screening, initiated by the Children’s Vision Foundation, started the process. This screening was timed to coincide with the start of the academic portion of the YCHS program. Fifty-six of the126 (44%) students who participated were found to need professional vision care. Eye/vision exams were done by a group of volunteer optometrists from Lane and Washington Counties and from Pacific University College of Optometry over a weekend by utilizing office space provided by a local optometry clinic. Of the 56 students examined, 36 were in need of a new lens Rx. Prescription glasses were furnished free to the students via an anonymous donor. Along with basic refractive problems including nearsightedness, farsightedness, and astigmatism, other visual dysfunctions included problems with eye movements, two-eyed coordination, near-far focusing, and visual information processing. These visual skills are basic to reading success and academic achievement and optometric vision therapy is the treatment of choice for dysfunctions of this nature.

Twenty-four of the students were placed into a vision therapy with each student receiving 60 minutes of therapy twice a week. Half of each hour is devoted to developing basic visual skills (near/far focusing, two-eyed coordination, eye movements) and half is devoted to enhancing visual information processing skills.

Staffing: The Children’s Vision Foundation, which is staffed by community volunteers, provided the initial vision screening. Volunteer optometrists from throughout the state staffed the pre- and post-testing examinations. Vision therapy is provided on-site through a combination of contract therapists and a community volunteer.

Dr. Sandra Landis is a volunteer serving as Clinical Director for the program, and Dr. Willard Bleything is a volunteer serving as overall Project Director.

Benchmark Measures: Care was taken to conduct a standard vision screening with established national norms. Tests for clarity of vision, refractive status, eye coordination, and eye movements were included. A test of visual information processing was also part of the initial assessment. Perhaps the most dramatic finding was this discovery: 99 of the 126 students (78%) fell in the lowest 25th percentile on the visual information processing test. This is a key finding because visual information processing skills along with eye movements skills have been found to have the most direct (visual) connection to reading ability.

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Resolution Adopted at the National PTA Convention, June 1999


Learning Related Vision Problems Education and Evaluation

"Whereas, it is estimated that more than 10 million children (ages 0 to 10) suffer from vision problems; and

Whereas, many visual skills are necessary for successful learning in the modern classroom; and skill deficiencies may contribute to poor academic performance; and

Whereas, typical "vision" evaluations/screenings only test for a few of the necessary learning related visual skills (distance acuity, i.e. 20/20 eyesight), leaving most visual skill deficiencies undiagnosed; and

Whereas, learning related vision problems, when accurately diagnosed, can be treated successfully and permanently; and..."

You can find the full Resolution online at: www.optometrists.org

Download the 1999 resolution here


You may be interested that in response to the 1999 resolution folks develop an on-line course:
www.sensoryprocessingcourses.com

Two Surprising Causes of Photophobia

By: Greg Mischio

Photophobia is a sensitivity or intolerance of light, and it can cause people to avoid sunlight, computers, fluorescent lights and car headlights. Instead of altering their life to avoid the stimuli that provokes light sensitivity, people should address the underlying cause of photophobia.

Our guess is that in many cases, people aren't aware of two surprising reasons for a person's light sensitivity:

1. Poor binocular vision
2. Accommodation

In case you’re not familiar with the terms, binocular vision is the process by which your two eyes work together to produce 3D vision. Accommodation is the process by which your eye changes its optical power to maintain a clear image or focus on an object as its distance changes.

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The story of Luci Baines Johnson

Luci Baines Johnson, former President Lyndon Johnson's younger daughter, struggled in school unable to get more than Cs and Ds because her eyes did not work well together and her total coordination was poor. Vision therapy and better physical conditioning gave her the vision skills to eventually succeed in college and in life. On November 7, 2015, Luci Johnson, together with sister Lynda Robb, was interviewed on NPR reflecting on the legacy of Julian Bond. She remains part of our vibrant, productive society but it could have been different. Her quote is still important to our discussion of children's vision needs.

"...if the key to a better society is a better education, then the key to a better education is better vision. If you don't have that key, you can't open the door to a better life."


Former President Jimmy Carter had a very difficult time finding the right specialist to help his grandchildren with amblyopia/lazy eye problems. He has publicly expressed his concern about early detection and treatment of the range of children's vision problems by his support of the Infant See program, which provides free eye exams for infants from 6 months to one year: www.infantsee.org

Can it be that only children who are very well connected can get comprehensive eye care?


Vision Issues in Foster Children. A remarkable progress after Vision Therapy

By Dr. Larry Lefors

This is the story of one of our foster care children who was adopted by the time the following events unfolded.

After three months of weekly in-clinic therapy the child’s vision greatly improved and her school performance began to improve as well. The child was delighted by how much easier it was to read.

The Infant SEE program (www.InfantSee.org) could have caught many of the vision problems of this Washington child and tens of thousands more while the children were infants. If the optometrists in our community and throughout our state checked carefully for focusing and tracking problems, and our children received early treatment for vision dysfunctions fewer of our children would be in special education, others would have better school performance and many would have fewer, or less severe, behavioral problems

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A letter from a foster mother

"We are sworn believers in advanced eye care and vision therapy."

Download Maggie's Statement to read more




Dr. Zaba's Call to Action

CHILDREN'S VISION CARE IN THE 21st CENTURY AND ITS IMPACT ON EDUCATION, LITERACY, SOCIAL ISSUES, AND THE WORKPLACE:
A CALL TO ACTION

by JOEL N. ZABA, M.A., O.D.

Prevalence of Children's Vision Problems
Experts estimate vision problems are prevalent in 25% of all schoolchildren in the United States and are one of the most prevalent handicapping conditions in childhood. Most of us assume schools are addressing the vision problems of children by performing vision screenings. However, research has shown that, of children in the 9 to 15 years old age group, only 10% of the children who needed eyeglasses actually had them.
Children’s Vision Screenings
When schools perform vision screenings, typically only distance vision is tested. However, most classroom activities, such as reading, writing, and computer work, involve the use of near vision. In order to assess adequately near-vision abilities and other potential vision issues that may hinder a child’s ability to learn, other tests need to be added to school vision screening procedures. At present, even when children with vision problems are identified during vision screenings, an alarming 40% – 67% of them do not receive the recommended follow-up eye exams or glasses. What does this mean to us as a society?
Consequences of Untreated Vision Problems in Children: Education, Literacy, and Social Issues
Children with undiagnosed and untreated vision problems grow up to become adults with undiagnosed and untreated vision problems. The failure to detect and treat vision disorders in children affects, among other things, such issues as childhood development, learning performance, self-esteem, socialemotional behavior, academic achievement, high school drop-out rates, and juvenile delinquency. From the standpoint of society in general, the failure to detect and treat children’s vision disorders affects the rates of adult criminality, literacy, and labor productivity.
Economic and Workplace Considerations of Untreated Vision Problems
Looking at the problem of undiagnosed and untreated children's vision disorders strictly from the standpoint of dollars and cents, a clearer picture of the costs emerges: It has been estimated that a mere 1% rise in literacy scores translates into a 2.5% relative rise in labor productivity  and a 1.5% increase in GDP per person. In 2006, U.S. organizations spent an astounding $5.8 billion on employee learning and development of basic  skills, such as remedial reading, writing, and math. Is there any doubt that children must have the vision care and vision skills required in order to perform successfully in school and workplace environments?

Download Call to Action paper to read more


SOCIAL, EMOTIONAL,&EDUCATIONAL CONSEQUENCES OF UNDETECTED CHILDREN’S VISION PROBLEMS

by JOEL N. ZABA, M.A., O.D.

Dr. Zaba presented at the Harvard 2001 conference and his 2008 Call to Action is an expansion of his paper. It is his attempt to keep alive the work discussed and information presented at the Harvard 2001 Conference in Vision and Literacy.

Abstract

This paper was designed for educators and related professionals who are concerned about learning problems in school-aged children, along with the consequences of these problems. The link between undetected vision problems, social and emotion problems, juvenile delinquency and illiteracy is reviewed. A multidisciplinary approach to deal with these problems is strongly advocated. On the basis of prior research, the author recommends that every child have a comprehensive vision examination prior to entering kindergarten, and additional vision evaluations and specific vision screenings through grade twelve.

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Underreporting of Concussions and ConcussionLike Symptoms in Female High School Athletes

by Tracy McDonald, MSN, RN / Mark A. Burghart, MOT / Niaman Nazir, MD, MPH

ABSTRACT

Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

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A letter from Dr. Stephanie R. Johnson-Brown to Seattle NAACP

Abstract

Stephanie R. Johnson-Brown, O.D. M.Ed. is an Executive Director of PLANO Child Development Center (Plano). For more than 50 years Plano has been meeting the needs of economically disadvantaged children who have under-developed and/or inefficient vision information processing systems.

Most of us are born with the ability to see, but what is not understood by many of us is that having effective vision - the ability through our eyesight to identify, process and understand what we see - is a learned skill that begins developing at birth. For many children, especially African-American children, the development of effective vision may be underdeveloped and directly affects their ability to learn and develop mentally, socially, and emotionally. Plano's comprehensive vision care program is designed to improve visual efficiency and visual processing, allowing the child to be more responsive to educational instruction. The program consists of several components: education, comprehensive vision testing, vision therapy, and pre and post testing evaluations.
I became involved with a vision and learning symposium Educating Young Eyes held November 8, 2014 at the University of Washington Bothell Campus. As a participate on one of the panels, I shared the view of a practicing behavioral optometrist servicing many underserved children as the executive director of Plano. The results of comprehensive vision care intervention have been life changing in my patients.

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Find out more about Stephanie R. Johnson-Brown, O.D. M.Ed. and her work at: PlanoVision.org

K. David Epley, M.D. about the vision screenings recommended by the American Academy of Pediatrics.


"Some states have vision screening laws, like Washington, but no states mandate screening in preschoolers at this point. The AAP recommends vision screening but only around 50% of pediatricians actually do this."

    K. David Epley, M.D.
    Children's Eye Care, PLLC



To find out more about Dr. Epley and his work, visit his website at: www.childrenseyecare.org

OPTOMETRIC CARE OF THE PATIENT WITH ACQUIRED BRAIN INJURY

A Joint Organizational Policy Statement of the American Academy of Optometry and the American Optometric Association

Abstract

Vision dysfunctions are among the most common sequelae associated with acquired brain injury (ABI). The anatomy and physiology of the vision system, the vascular and neural network of the brain, and the dynamics of head trauma all contribute to the high incidence of visual dysfunction in this population. Causes of brain injury which may contribute to visual dysfunction include blunt, penetrating, or acceleration/deceleration trauma; cerebral vascular accidents; whiplash injury; suffocation/hypoxia; and pharmacological toxicity. A significant number of patients with ABI will present with signs and symptoms which may indicate a vision problem.

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SYMPTOMS SIGNS of ACQUIRED BRAIN INJURY:
These include, but are not limited to, the following:
  • Blurred vision
  • Abnormal body posture
  • Confusion when performing visual tasks
  • Balance and coordination problems
  • Dizziness/vertigo
  • Bumping into objects
  • Difficulty reading
  • Closing or covering one eye
  • Double vision
  • Eye misalignment
  • Eye strain
  • Head tilts or turns
  • Headaches
  • Poor judgment of depth
  • Reduced ability to sustain attention
  • Reduced ability to accurately visual tasks localize objects
  • Visual fatigue

Professor Maino's letter of support


"...Children cannot learn if their vision information processing systems are malfunctioning. Many of these children already have several other hurtles they must overcome to be successful. Let’s make sure that learning related vision problems are not added to that list."

    Dominick M. Maino, OD, MEd, FAAO, FCOVD
    Professor of Pediatrics/Binocular Vision
    Illinois Eye Institute/Illinois College of Optometry


Could Vision Issues Be Contributing to Your Child’s Difficulty With Learning?

By Debbie Walhof, MD and Leonard Press, OD

Abstract

Parents and educators often ask us questions about vision therapy and if it can be helpful for children with LD. While vision problems are not the cause of dyslexia or other learning disabilities, vision issues such as convergence insufficiency can certainly interfere with learning and contribute to difficulties with attention and behavior. And some practitioners report that convergence insufficiency may be more common in individuals with LD and ADHD.

We turned to a pediatrician, Debbie Walhof, MD, and an optometrist, Leonard Press, OD, to answer questions about vision therapy, convergence insufficiency, and what parents should know if they are considering vision therapy for their child.


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Dr. Power's letter of support


"...current practices in school and (sadly) often also in doctor's offices do not identify reading-related vision problems. And as you have said - and our data support this assertion - foster children, children of color, juvenile offenders, and children living in poverty are more likely to have vision problems than others. "

    Maureen Powers, Ph.D.
    Senior Scientist


Vision Case Studies of Students in California Schools, Grades 3 through 10

40% of 3721 students tested in two school districts, a charter high school, and an after school program experience significant discomfort while reading or trying to study. Research shows that having symptoms like these correlates significantly with low reading fluency scores. Other research shows about 10% of these students need full eye exams and possible visual correction. The remainder passed school screening and would never be made aware that their visual system - a physical problem – could be holding them back from faster and more efficient reading. Current school vision screening will catch only about ¼ of these children – the rest will continue to be uncomfortable or actually see words wiggle around or come in and out of focus while trying to read.

No wonder they quit reading!
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To find out more about Dr. Powers and her work, visit her website at: www.eyesinconflict.org


Former Professor Edley

Former Dean Edley spoke at a "Forces of Change" conference at the University of Washington School of Law in 2012 and in his keynote linked high incidences of undiagnosed vision impairments to students of color not meeting reading and math proficiency tests for their grade level.

Christopher Edley is a former professor and former dean at Berkeley Law School, and was co-chair of the congressionally chartered national Commission on Education Equity and Excellence. He was most recently director of the law school's Warren Institute of Law & Social Justice, but we understand he has had a medical retirement.

"For more than two decades, I've been concerned about the link between student achievement and undiagnosed and untreated vision problems. In some districts, the problem is endemic, reflecting breakdowns in both our health delivery and school systems.
From an education policy perspective, I believe this is second only to hunger as the most important poverty-related problems we can actually do something about. Now."
Christopher Edley
Former UC Berkeley Professor of Law




Increasing driving vision safety with Dr. Floyd Mizener

Jim Edgar appointed Dr. Floyd Mizener as Chairman of his Vision Advisory Committee. As a result of the work of this committee, three Optometrists and three Ophthalmologists, the changes it made in the vision screening in Illinois were dynamic, thereby increasing driving vision safety. The number of fatalities has continually been reducing since 1982 (2,800 annually then) to 964 fatalities last year, with two million more drivers on Illinois roads.

To further reduce vision driving errors, the House of Representatives passed a Resolution developed by Lion Dr. Floyd Mizener and proposed by State Representative Patti Bellow HR 0385 in May of 2015 to encourage an annual professional eye and visual examination which would include testing of peripheral vision, binocular vision, depth perception and care for the protection of dangerous sun and halo glare. The Rules of the Road carries a statement that a vision screening is not an eye examination. Illinois’ Vision Testing example has filtered to other states and countries. Every life saved is important.

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A support letter from Dr. Kathleen Ross

This letter is written to bring to your attention the high price we pay as a society for failure to provide better vision care for our children and youth...

Dr. Kathleen Ross, snjm, Ph.D.
Heritage University President Emerita & Professor


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Dr. Pellicer’s Letter to DSHS Children’s Administration Administrators & Staff

July 25, 2013

As a family physician in the state of Washington, I am writing to express my deep concern and alarm as I have learned about a huge hidden epidemic of undiagnosed vision problems in our children. Due to a long standing system failure, most children in our state do not get examined or even screened for binocular dysfunctions.

We do screen for distance vision with the Snellen chart but this does NOT screen for binocular dysfunctions (an inability of the eyes to work together and function well at close range which is needed for reading). Shockingly, in most of the screenings that I am aware of 25-30% of children have some level of binocular dysfunction. Yes, 25-30% of our school age children have a vision problem that is preventing them from being able to learn properly as about 80% of learning occurs through the visual system. What’s more this problem is treatable in the majority of cases, but not with glasses or surgery.

In studies of children who are placed in special education classes, other remedial education classes and those identified as juvenile offenders the rates of binocular dysfunction are between 50-70%. These children have a correctable vision problem that is now being totally missed by the health care and educational systems. And I think it is safe to say that at least some of their problems of failure to thrive in society and in the education system are due to an inability of their eyes to function well together, a skill that is mandatory for negotiating the educational system.

Now that this problem is being brought to our attention, I feel it is vital that we take action and correct our societal oversight that has such devastating effects for this huge segment of our school age population. Certainly any child at risk, including all foster children, children with special needs, children in any type of special education or struggling in school and all juvenile offenders need to have a comprehensive vision exam by a developmental optometrist who has the ongoing experience and expertise in diagnosing all the binocular dysfunctions.

I urge you as members of the children’s administration, who’s important mission is to identify the needs of children and assure their safety and well-being, to become aware of this overlooked problem of binocular dysfunction in our children and use your talents and skills to be a part of the solution.

Thank you,
Mary Pellicer, MD

Download the entire document here


WA State issued new vision screening requirements effective 7/1/17 to address vision issues in children: View the new legislation here



Dr. Lenart’s Letter to Dr.Manley

January 25, 2013

Dear Dr. Manley:

I have been working with you for about 13 years and as you know I feel very strongly about the issues of binocularity in children. I feel that the issues of binocularity in children ... can definitely impact their ability to do well in school, in sports and just in life in general. I feel that the issues of binocularity in children are vastly underdiagnosed and that more attention should be focused on that...

Sincerely,
Thomas D. Lenart, M.D., Ph.D.



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Katie Johnson’s Letter of Support

February 12, 2012

To Whom It May Concern:

Children in even an affluent district have eye-tracking and eye-teaming problems which are only accidentally discovered. In my teaching life I have had about 30% of regular education students who needed intervention by a developmental optometrist; in groups of children who are already targeted as non-readers, I have had up to 70% of children who needed vision help.

As a teacher of reading in grades 1-6 for nine years (in the Washington state Learning Assistance Program) and as a teacher of ?rst grade and Kindergarten for the past six years in the Shoreline (WA) school district (after 18 years teaching ?rst grade in Maine), I have seen many puzzling children. These are the children who ought to be able to read and can’t.

I have studied with developmental movement and vision therapists to try to begin to understand what to look for and whom to refer for what. During these past ?fteen years I have developed a set of movement and vision activities and exercises to help teachers with their puzzling children.

(I have published these in my latest book, Red Flags for Primary Teachers: Vision and Neurodevelopmental Issues and What to Do About Them.)

I wholeheartedly support the possibility of a focus on developing a vision screening system for ALL children of school age. Children, and teachers, become very discouraged when there does not seem to be a reason for their failure with teaching and learning reading.

It would be wonderful for children and for teachers if initiatives in Washington State could come to fruition. I hope that Microsoft will give serious consideration to the idea of a symposium in 2014 on vision and learning/education, to begin this much-needed process. Thank you for your attention.

Sincerely yours,
Katie Johnson
Teacher

Download the entire document here


WA State issued new vision screening requirements effective 7/1/17 to address vision issues in children: View the new legislation here



Educational Opportunity though Better Vision Care

July 16, 2013

We have spent hundreds of billions of dollars and enacted a seemingly endless set of educational reforms and programs over the past generation attempting to equalize educational opportunity and to improve the life chances of poor and minority children in an increasingly unequal society which is falling behind its major international competitors in international competition. I have been working on issues of educational reform and educational opportunity throughout my career. Research shows that most reforms failed and that deep gaps remain.

I have long been convinced that a fundamental mistake of the reforms has been the assumption that all the problems can be solved by teachers inside classrooms. It is obvious to many of us who have studied this closely that many of the forces that produce and perpetuate inequality originate outside the classroom and must be solved if the students and the teachers are to have a fair chance. This is why I was particularly fascinated and impressed by the original work and research my late wife, Dr. Antonia Orfield, carried out in a clinic she ran for years in a historic Boston public school. She found that a shockingly high proportion of students had untreated vision problems that were not identified through standard methods of vision testing and that directly affected their ability to learn. Many of them were not the kinds of problems we commonly expect in children but the kinds of problems older people often face. She also found that although many of the families of the children were poor and eligible for Medicaid, the system worked poorly and children did not get the glasses and treatment they needed or could not get them replaced when, as children will, they broke or lost their glasses. She had many cases where children who were doing very poorly in classes improved markedly when treated appropriately. Sometimes the treatments were very simple. An M.D. and one of my advanced doctoral students at Harvard analyzed her data and found significant relationships.

I am not an expert in vision but I am an expert in educational and social policy. I decided that this was a no-brainer. When the public was paying $12,000 a year to educate a student and another $5,000 for Medicaid and the money was being wasted and the student’s future threatened for the lack of a $100 pair of glasses, it was truly senseless. This was why I was very happy to sponsor what became known as the Harvard Conference in 2001 where researchers from across the country produced data showing similar problems in many settings and discussed experiments in initiating better practices. There were striking parallels in the data and the work clearly called for a serious national examination of the issue and the launch of major experiments and policy initiatives to address it. As usually happens, however, the response of the educational and medical establishment in many cases defended the status quo and traditional methods.

Gary Orfield
Distinguished Research Professor of Education, Law,
Political Science, and Urban Planning, UCLA


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Foster Children are Especially at Risk for Poor Vision Care; Negligent Parents Fail to Promote Good Vision Skills

September 11, 2017

My daughter is a foster parent and I see firsthand the problems foster children have.

Larry Lefors, DO
Zillah, WA

Download the entire document here




"Eye" don't see the connection between vision and learning in the Yakima Valley!

Findings from a Review of Existing Literature and Community Interviews for The AmeriCorps Child Vision Project Division of Children and Family Services –Toppenish
Prepared by Barbara Obena, MPH
Edited by Helen Spencer and Katie Johnson
University of Washington School of Public Health
Community-Oriented Public Health Practice Program
July 2013

Executive Summary

Children in the state of Washington do not receive comprehensive vision exams because it is not a requirement prior to entering schools, nor performed by primary care providers at well-child exams. Instead, Washington requires vision screenings via the Snellen chart. However, the flaw with this vision screening is that a Snellen chart only checks for distance visual acuity (i.e. whether a child can see the board) and not functions associated with close up work – focusing, teaming, moving across a line. As a result, a student with one or more undetected visual dysfunctions may have difficulties learning in school and thriving in life.

During 2010-2012, the AmeriCorps Child Vision Project helped facilitate comprehensive vision exams for 85 foster children at the Department of Child and Family Services — Toppenish Office. Because vision problems may interfere with the ability to learn, the Project speculates that similar figures may exist in children who have learning disabilities and are classified as special education; hence, the desire to study this population more in depth.

The author examined existing literature and interviewed community members to understand the issue of child vision at the local level. Recommendations for the future of the Project were created based on findings from literature, what community members proposed, and from the author’s personal observations working directly with the Project.



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Vision Problems in Children

An Examination of the Vision Problems and Access to Vision Services among Children in Washington
Prepared by: AMERICORPS CHILD VISION PROJECT/2010-2012


Summary


Vision problems are prevalent worldwide and in the United States, and can be extremely detrimental to children. There is high prevalence of vision problems among children in the United States across ethnic and socioeconomic groups. Vision screening and comprehensive vision exams are both important methods to catch undiagnosed vision problems. However, not every child has access to vision screenings and even fewer have regular access to comprehensive vision exams.

Three types of vision problems affect children: eye health problems, vision acuity problems, and binocular vision problems. Vision problems can cause learning problems because of the way in which the visual system is used for academic performance. Children who cannot see well may have difficulties with schoolwork. Visual factors have been found to be a better predictor of academic factors than race or socioeconomic status. In order to prevent vision related learning problems early detection and treatment is important. It is important to do this early before a child gets behind in school. There needs to be more advocacy and research to address vision problems, which can have lasting and widespread consequences if left untreated.

Untreated vision problems can be costly. There can be enormous costs to education that could potentially be saved by early detection and treatment. However, cost can also be prohibitive to people looking for vision services, and this must be addressed so that individuals are able to adequately treat their vision problems. The costs of ignoring the problem can have high societal costs in addition to costs to an individual’s quality of life. Vision problems can complicate co-existing conditions and increase the expense of addressing these conditions as well. One way to combat the costs of undetected vision problems is by increasing access to vision services.

Certain populations may be at higher risk for not having access to vision services, thus leading to undetected vision problems. One in particular is foster children. In addition, rural communities have less access to vision services. Native Americans have high rates of undetected vision problems.

A solution to address this issue may be to integrate vision care into existing services. The AmeriCorps Child Vision Project is an example of how this can be done. The program was created in 2010 to work with caseworkers and foster families to help facilitate access to vision services. It was found that 44% of children had undetected vision problems. This is similar to a 2000 study of foster children in New York City that found that 44.4% of foster children had undetected vision problems. These figures exemplify the importance of programs that increase access to vision services for needed populations


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An Excerpt of Dr. Bob Mc Laughlin's book
"A Crisis in American Education: A Love Story".

With permission from the author we extracted the part on Binocular Vision from Chapter 9 of his book

Chapter 9

Binocular Vision

Most would agree that the ability to read would require the eyes to work together in tandem, like a team, to gather information from the text presented as printed objects on a page. This is frequently referred to as binocular vision and/or convergence.

A binocular vision problem occurs when the six muscles that each eye uses to control eye movement are not functioning correctly. Each eye also has three different cranial nerves whose duty is to control the muscles in the eye. When the eyes are looking straight ahead, the eyes are in the resting position, when looking at a distance. Normally, the eyes turn in slightly when looking at something close up. Eyes that are not aligned together when doing this have to make heavy corrections to keep from seeing double. This requires extra energy from the brain – and loss of that energy for some people causes fatigue and visual instability.

I could only identify four American states, Alaska, Arkansas, Illinois and Kentucky, that require tests to determine whether children’s eyes work together properly. Called binocular vision assessment, it is just as controversial as both Dee’s methods for reading instruction and testing students for Irlen syndrome. There are three professions in the U.S. that address vision and, notably, the three disagree on the importance of binocular vision for success in school. Ophthalmologists are medical doctors who focus primarily on the mechanics of the eye. They are doing some work with convergence, or the ability of two eyes to move and work as a team. Optometrists perform vision assessments and prescribe glasses for both distance vision and near vision. They also diagnose issues related to binocular and/or convergence insufficiencies, but appropriate treatment requires additional training. Developmental optometrists routinely test for and treat for binocular and convergence vision problems – and their methods still have limited acceptance with both ophthalmology and general optometry.

The American Optometric Association has published and regularly updates a position statement on vision issues that affect learning. It can be found online at: www.aoa.org/optometrists/education-and-training/clinical-care/vision-learning-and-dyslexia?sso=y.

Fundamentally, the vision professions do not agree on the importance of binocular vision as it relates to learning. Part of the problem is time – it takes a very long time for old ideas to die away and new ideas to take over. Another issue, though, is contradictory research results. The contradictory results frequently involve reading and the assumption that reading should improve if binocular vision improves. Researchers who think this way should reconsider. If Dee is correct and a neural network guides the act of reading, whether or not the neural network was built correctly in the first place ultimately controls whether or not an individual reads well. Suggesting that fixing the vision problem will simultaneously fix the reading problem is fundamentally flawed. True—treatment is likely to improve clarity and stability of the text (which may yield some notable improvement in reading), but it does not fix how the reader actually reads. To fix that, you have to help the student correct the reading problem through coaching.


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The College of Optometrists in Vision Development – QOL Questionnaire in a socially at-risk population of youth

Willard B. Bleything, OD, MS, FAAO, FCOVD1, Sandra L. Landis, OD, FCOVD2

Abstract:

Background: The literature reports a high prevalence of visual dysfunction in those populations that are socially at-risk. This research is designed to determine the effectiveness of the College of Optometrists in Vision Development - QOL (COVDQOL) Questionnaire in this special population.

Methods: Youth enrolled in a special high school (n=123) were given vision screenings followed by comprehensive optometric examinations for those referred (n=55). Twenty-four were placed into a vision therapy group and 31 into a control group for a period of 12 weeks. Prescription lenses were also provided, as needed.

Results: Significant differences were measured on the COVD-QOL between those who passed the screening and those who failed. Also, significant pretest and post-test differences were found on those subjects within both the vision therapy and control groups. When a cutoff score of 20 was used, the vision therapy group showed greater improvement in symptom scores than the control group.

Conclusions: The COVD-QOL questionnaire differentiated between subjects found to be at visual risk and those not at visual risk when using overall scores and cutoff scores and is better suited to measure pre-test/post-test intervention results rather than as an alternative visual screening battery.

Key Words: At-risk youth, QOL, quality of life, optometric vision therapy


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Visual Impediments to Learning - A Study from Canada

By Noëlla Piquette, PhD, University of Lethbridge, Lethbridge, Alberta, Canada
Charles Boulet, OD, Black Diamond, Alberta, Canada


ABSTRACT

Cognition, learning, and motor planning are dependent upon accurate encoding of stimuli from the environment. If there is an error in, or an impediment to, sensory perception, higher cognitive functions, such as reading, memory, emotional awareness, and impulse control can be affected.

In schools, deficiencies of the visual process impede and impair reading acquisition and learning and influence other behavior. Children are affected by different types of functional impediments to eyesight and visual function. The degree to which children are impacted varies according to the depth and nature of the impediments present, and to some degree to socioeconomic status. Some children are at a greater disadvantage simply because of the greater visual demands of the neo-traditional classroom.

These visual impediments to learning (VIL) are rarely detected in common sight screenings and are associated with limited socioeconomic success and increased criminality. Significant VIL limit academic and life outcomes, with some ethnicities affected by a greater prevalence of reading-impairing impediments. This presents difficulties for various public agencies at all levels of government. To complicate matters further, children who are affected by vision difficulties will most often not report the problem, nor will VIL be detected during standard pediatric or psychoeducational assessment.

VIL are described in brief, as is how they alter children’s academic outcomes, health, and behavior. A model of sufficient vision care in the prevention and management of most vision-related learning and behavioral difficulties is proposed. The position is advanced that ensuring adequate vision management for children entering the 12-year academic cycle is a matter of fundamental human rights.

...clinical and epidemiological studies will show that reduced distance acuity due to myopia is not associated with reading delays, and this is consistent with other findings. It is also clear that low to moderate levels of myopia present as a relative advantage in the classroom compared to hyperopia, even though hyperopia is much less likely to be detected in rarified vision checks. Children with astigmatism, hyperopia, and other nonmyopic visual difficulties, and who can still read distance eye charts, can and do struggle with reading. Consider that children who cannot see clearly at a distance are much more likely to be myopic than hyperopic. For example, a child who is farsighted by two diopters will pass a distance acuity check, while a two-diopter myope will see blurred lines. However, the hyperopic child is much more likely to struggle academically.

Keywords: ADHD, ethnicity, human rights, learning disability, public health policy, vision, visual impediments to learning

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A Clear Vision for Equity and Opportunity

By Gould, Marge Christensen; Gould, Herman

A study from Boston that looks at the effects of inadequate vision care in youth

Educators work very hard to help students solve the cognitive problems that impede their learning. Sometimes, the authors argue, it's the problems we can't "see" that need to be fixed first... schools need to address a much more basic issue affecting learning for many students, especially those who live in poverty. This is the issue of undetected and uncorrected vision problems.

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Recommendations for the new EYE Center for Children’s Vision, Learning & Technology at the University of Washington Bothell

Presented by Dr. Kathleen Ross, snjm, President Emerita of Heritage University;
Rhonda Stone, Author, The Light Barrier (St. Martin's Press 2002 & 2003);
Katie Johnson, Retired Teacher and Author;
Mary Pellicer, MD, May 2017


Summary
A Center for Vision, Learning and Technology is critical if we are to address the vision needs of our population. The narrow medical model/question, "is the eye healthy?", is inadequate to assure that children and youth are able to read comfortably and with good comprehension. The appropriate and accepted standard is what constitutes a "well child."

A Center will develop a clear and verifiable definition for convergence insufficiency and then develop reliable data for just how common this particular problem is. Other eye coordination issues can also be identified and quantified. The effectiveness of computer treatment programs and other vision therapy will be studied until there is agreement on what procedures are most helpful.

The work of an independent Center, not affiliated with an optometry school, will provide needed credibility to this work.

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To learn more about the Center for Vision, Learning and Technology at UW in Bothell and it's projets, visit: www.educatingyoungeyes.org

Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children

Lead authors: Mitchell Scheiman, OD; Susan Cotter, OD, MS; G. Lynn Mitchell, MAS;Marjean Kulp, OD, MS;Michael Rouse, OD, MEd; Richard Hertle, MD; and Maryann Redford, DDS,MPH.
Additional writing committee members (alphabetical): Jeffrey Cooper, MS, OD; Rachel Coulter, OD; Michael Gallaway, OD; David Granet, MD; Kristine Hopkins, OD, MSPH; Brian G. Mohney, MD; and Susanna Tamkins, OD.

Objective: To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), officebased vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency.

Methods: In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments.

Main Outcome Measures: Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near.

Results: After 12 weeks of treatment, the OBVAT group’s mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7, and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P<.001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P<.005 for all comparisons). A successful or improved outcome was found in 73%, 43%, 33%, and 35% of patients in the OBVAT, HBPP, HBCVAT+, and OBPT groups, respectively.

Conclusions: Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP, HBCVAT+, and OBPT.

Application to Clinical Practice: Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.

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The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders

by Kenneth J. Ciuffreda, O.D., Ph.D.
State University of New York, State College of Optometry, Department of Vision Sciences, New York, New York


Summary

Background: For nearly 75 years, optometric vision therapy has been an important mode of therapy for both children and adults who manifested a range of nonstrabismic accommodative and vergence disorders.

Methods: In this article, the scientific basis for, and efficacy of, optometric vision therapy in such patients will be discussed. Using bio-engineering models of the oculomotor system as the conceptual framework, emphasis will be focused on studies that used objective recording techniques to directly assess therapeutically related changes in oculomotor responsivity.

Results and Conclusions: The findings clearly support the validity of optometric vision therapy. Furthermore, the results are consistent with the tenets of general motor learning. Key Words: Accommodation, behavior modification, motor learning, oculomotor plasticity, oculomotor responsivity, vergence, vision therapy

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Optometry and Vision

by William E. Cochran, OD
Southern College of Optometry, President Emeritus

As I approach the close of a 40- year career in optometry, I have become increasingly concerned that our profession is in danger of losing that uniqueness. External and internal forces tend to encourage our attention to be directed to the care of eye sight rather than to the care of vision. We tend to limit our care to the ability of the receiver (the eye) to function properly either through refraction or health. The care of vision, which not only includes refraction and eye health, goes much further.

Vision includes the cortical response or interpretation of the light stimulus received by the eye and usually an action or motor output. Vision is a learned process. As optometrists we learned all about this during our optometry school experience. This is what makes what we do as a profession so distinctive.

External forces that may endanger our uniqueness can include society’s commercialization of eye care, various third party payers that require more work for less fi scal compensation (or that do not fi scally recognize what we do as reimbursable), and a public demanding services and products that are delivered cheap and fast. Internal forces are also a concern. The profession’s emphasis on the diagnosis and treatment of ocular health anomalies has without doubt moved optometry forward, but that emphasis may have overshadowed what makes us unique.

Our profession and society has experienced immense changes over the past 40 years. Optometry has successfully expanded our scope of practice to become the true primary eye and vision care providers in the United States. That scope of practice still includes a thorough knowledge of Prentice’s Rule and all of its ramifi cations. It also includes optometry’s distinctive understanding of vision and the learning process.

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Vision and Audiology Status of Foster Children in New York City

by Trudy Festinger, D.S.W. & Robert Duckman, O.D., M.A


Abstract

Between January, 1998, and July, 1999, 351 children in foster care placements in New York City received comprehensive visionexaminations. Onehundredandfiveof these children also received a hearing evaluation. The children from one of the sites (St.Christopher-Otillie, Brooklyn)were also examined in the audiology department of Brooklyn Hospital. The children were the charge of three different agencies at four sites. The aim of the study was to investigate the visual status of children in foster care placements and whether or not those children with significantvisualproblems were being identified and followed. Visual acuity, ocular motor function, refractive error, ocular health status, eye vergence skills and stereopsis were evaluated in the vision examinations. Anomalies were rated mild, moderate and severe, newly or previously identified and whether they were likely or not likely to have been present one year earlier (the time of their last physical). In all areas tested, children in foster care had higher prevalences of visual and audiological anomalies, than their «normal» counterparts. Theresultsindicatethatthevisionandaudiological screenings now being provided tothesechildrenattheirmandatedannual physical examination, are not sufficiently identifying children with moderate or severevisionandaudiologicaldysfunctions.

Key Words: foster children, vision, audiology, refractive error, visual acuity, convergence, stereopsis, ocular motor function

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The Visual Screening of Adjudicated Adolescents

By Roger A. Johnson, Ph.D. & Joel N. Zaba, 0.D.

The New York State Optometric Association Vision Screening Battery (NYSOA) and the Developmental Eye Movement Test (DEM) were administered to 50 adjudicated adolescents in order to isolate which particular visual factors are most responsible for the learning difficulties of juvenile offenders. Fifty four graduate students served as a control group. A multiple regression statistical analysis indicated that the Tracking and Convergence subtests of the NYSOA were statistically significant predictors of reading and language arts achievement scores. A chi-square statistical analysis revealed that the juvenile offenders scored significantly lower on the Tracking, Visual Acuity Near, and Color Vision subtests. The most significant finding was the high failure rate of juvenile offenders on both tracking tests. Forty eight percent failed the tracking subtest of the NYSOA. Sixty eight percent failed one or more of the DEM subtests.

The impact of juvenile delinquency on our society and its ramifications, such as crime, are well known and undisputed. American youth are being incarcerated at a continually increasing rate and cost. American prisons now hold an ever increasing number of prisoners as many juvenile offenders develop into adult criminals. In 1994 there was a total of 950,000 prisoners incarcerated at a cost of $35,000 to $60,000 per inmate.

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Optometry Community Outreach EyeVan

by Pacific University College of Optometry


Abstract

Pacific University College of Optometry Community Outreach program provides vision screenings, examinations and education to the community.

Vision screenings are performed at head start preschools, elementary schools, vineyards, migrant camps, health fairs and other locations. The mobile EyeVan is utilized for vision assessments throughout the community.


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College of Optometry Awards Larry Jones OD '85 its 2017 Kamelia Massih Prize for a Distinguished Optometrist

By Joe Lang

Dr. Jones received the honor from College of Optometry dean and fellow alumna Dr. Jennifer Coyle '90, OD '93, MS '00 during Pacific's spring graduate and professional program commencement ceremony on May 20.

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